The secondary defect in the cheek caused by the rotation of the flap is closed by suturing the raw surfaces together.
The resulting mouth will be much smaller than normal, having a puckered appearance. A secondary operation, mentioned later, is employed to correct this.
Fig. 202.—Buck Method.
Estlander-Abbé Method.—Estlander and Abbé employed a transplantation flap of triangular form taken from the lower lip to restore median defects of the upper lip, whether due to a deficiency of the latter following harelip operation or the extirpation of a malignant growth.
Where the tissues operated upon warrant such procedure this operation will give excellent results, leaving the mouth almost normal in shape and size.
The lower pedunculated flap is made by cutting directly through the entire thickness of the lip, including the prolabium at A ([Fig. 203]), and downward toward the median line to the point B, thence upward to the margin of the vermilion border at G, leaving the latter to form the pedicle of the flap F. The defect is freshened by either a median incision, D, E, or the ablation is made in triangular form.
The flap F is now rotated upward and sutured into the upper lip, as shown in [Fig. 204]. The triangular defect thus made in the lower lip is sutured along the median line.
The prolabial pedicle of the flap F is not divided until about the eighth day, when the vermilion borders of both the upper and lower lips are restored by the aid of the free stump ends, which are neatly sutured into position, as shown in [Fig. 205].